Binley, Baby boy 1 orm"VS. 61. NEW- YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pr This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE Of
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No, ,'"0
--- eptrrr-,
Dist. Not.S.1.0./.....County. 4A-ti-
,.., / City (If city. give street address) ,
Name of deceased 'if -
ai Single, ma f ed, wido d, _ ..i„.:a
.Sex..21 ..... .C.Iolor or divorced (write th word) Date of e, c't-,-,- 4?"- Y 19.X.1.
Age ----- Year ---` . .. Months ---. Day:-$1-O le'.fe... . Birthplace Z---- 247."frrx-tr
Cause of Death ..Certificate was signed I - ./ ... M.D.
Address /— ,
i
__...--- . ,
Place of Burial (or R - -)val } /....62- 141,..
7
(If body is to be tempos , ield, iiil in spate later) /
Cemetery (..Z..1-Z-2, "---(4. ,----4,, Date of Burial 19
(If body Is to be temporarily iii.i.i, tin in space later)
The Certificate of Death containing the above stated particulars. having been pres nted to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acce.rt the same for re *stra ' n, hay r orded it in my Lo e ord with the boy stated Registered
Number, a4 o the basis f I ERE NT A PERMIT .
ce
AO/ Ne4•1/ Ad
the to hold temporarily the body.
(Unit aker or persig ha-*.g charge c se) re ,or othr'ise s of[a ow])
Dated
Local Registrar
This mit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State subject to local
0
e ery . other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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